Manila, the Philippines – There is a high prevalence and high economic burden of community-acquired pneumonia in the Philippines. At present, the Philippine Health Insurance Corporation (PhilHealth) coverage for Community-acquired Pneumonia-Moderate Risk (CAP-MR) and Community-acquired Pneumonia-High Risk (CAP-HR) are PHP 15,000 (US$354) and PHP32,000 (US$754), respectively.

The objectives of the study were: 1) to determine the cost of hospitalization and 1-week after hospitalization for pneumonia; 2) the difference between the estimated costs and PhilHealth pneumonia case rate payments; and 3) the economic burden of community-acquired pneumonia among patients age 19 years and older in the Philippines.

Based on the study results for the cost of hospitalization for pneumonia and PhilHealth claims for 2012, the cost for hospitalization for community-acquired pneumonia for CAP-MR and CAP-HR were PHP 8.48 billion and 643.76 million, respectively. Apart from significantly higher from those calculated based on the PhilHealth case rate payments, these figures more accurately reflect the true economic burden of hospitalization for pneumonia in the Philippines.

“The study results are notably disparate from the present PhilHealth case rate payments, thus the corresponding difference between the two needs to be shouldered either by the patient or the patient’s relative or by the government hospital in the case of indigent patients. This has both equity and economic implications which are discussed in the study.” the presenting author, Bernadette A. Tumanan-Mendoza, MD, MScCE, MHE, Consultant, Department of Internal Medicine, Manila Doctors Hospital and a faculty member of the Department of Clinical Epidemiology of the University of the Philippines Manila College of Medicine, quoted.